8. Implications for policy, programming and future research

what is urgently needed is government anti-discrimination policy supported by a law that will ensure the protection of (HIV) positive people’s rights

The local studies of the determinants of HIV/AIDS-related stigmatization, discrimination and denial described here took the form of extended rapid assessments of six months’ duration. When originally planned, they were seen as the precursors to subsequent enquiries involving larger numbers of respondents and a more in-depth approach. Given the scope and nature of the enquiry, therefore, it would be unreasonable to expect detailed policy and programming implications to be derived from the data. This was not the aim of the local investigations carried out.

greater attention needs to be given to the gender-biased nature of HIV/AIDS-related stigma

However, with respect to policy development the following general points can be made:

· Efforts to tackle HIV/AIDS-related stigmatization, discrimination and denial seem doomed to fail in the absence of a supportive legal framework. In the words of the India report, “It is not enough to spread awareness about HIV/AIDS, its transmission matters or even about legal rights. What is urgently needed is government anti-discrimination policy supported by a law that will ensure the protection of (HIV) positive people’s rights.”

· Even where such laws exist, or where governments make active efforts to combat HIV/AIDS-related discrimination, it is vital to challenge popular myths, stereotypes and judgements that provide the ground upon which HIV/AIDS-related stigma can grow. At the policy level, prevention programmes should foster tolerance and social solidarity using, wherever possible, an approach which is non-judgemental and not based on fear.

· In both employment and health care, discriminatory policy needs to be developed to protect and safeguard the employment and health care rights of people living with HIV/AIDS. Central to this must be principles of confidentiality and respect for human rights.

· Interventions targeting discrimination need to take place concurrent with the establishment of a supportive legal framework that includes generic anti-discrimination laws covering health care, employment, education, housing and social security, as well as effective enforcement mechanisms. Other important and complementary activities must include efforts to change attitudes through communication campaigns in the media, education and training.

In future prevention, care and impact-mitigation programming:

· Interventions and activities should aim to move from providing only information to providing services and social support aimed at countering the prejudices and popular beliefs about HIV/AIDS that seemingly justify stigmatization and discrimination.

· Greater attention needs to be given to the gender-biased nature of HIV/AIDS-related stigma. Efforts should be made to address not only women’s risks of HIV/AIDS infection but their heightened vulnerability to the social stigma associated with HIV/AIDS. In the majority of societies, a double standard exists whereby men are permitted (and even encouraged) to have more than one partner, while women are blamed for the consequences of this behaviour. The effects of this double standard on women’s health and well-being, property rights and rights of access to children are serious, and need to be addressed urgently.

· Efforts must be made to tackle the forms of felt and enacted stigma that make it difficult for people living with HIV/AIDS to be open about their serostatus. This secrecy causes them to withdraw from social life, and makes it difficult for them to play a full part in prevention and to benefit from care.

With respect to future research, more needs to be learned about:

· The overt and the more hidden and institutionalized forms of HIV/AIDS-related stigmatization, discrimination and denial that exist in different settings and at different stages of the epidemic.

· The determinants of these different kinds of HIV/AIDS-related stigmatization, discrimination and denial, and the circumstances and factors that lead to a reduction in stigmatization and its negative consequences.

· The pervasive discursive, cultural and structural frameworks that act as sources of HIV/AIDS-related stigmatization, discrimination and denial, the manner in which these are utilized and resisted, and their consequences for the social exclusion of certain categories of individual.

· The processes and dynamics of exclusion that accompany HIV/AIDS-related stigmatization, discrimination and denial, including the self-exclusion associated with felt stigma and the collective exclusion associated with institutionalized forms of discrimination.

· The positive responses to which HIV/AIDS-related stigmatization, discrimination and denial can give rise, the circumstances in which these occur, precipitating and supporting factors, and the key parties involved.

· The price that societies and communities pay for HIV/AIDS-related stigmatization, discrimination and denial, its impact upon family and community, health care systems, labour and productivity.